Figure 2. The stakeholders participating in Community Science
initiatives.
The strategies listed above provide guidance in implementing prevention
measures of different scales of society. Nevertheless, efficient
prevention requires the close collaboration of not only partners within
a certain program and scale, but partners across diverse scales.
Information and expertise coming from grassroot science must be utilised
to design and implement intervention plans on regional levels, which
will feed into global frameworks collecting exemplary cases and
efficient methods to be applied on other reservoir-pathogen systems in
diverse policy environments.
Implementation strategies
in different policy environments
When reviewing various EIDs, outbreaks and epidemics are often dealt
with by different legal and economic frameworks depending on not only
the scale they manifest on, but also on the newly infected host.
Pathogens emerging in human communities, for instance, will come under
the jurisdiction of public health and healthcare institutions, which has
already resulted in the false interpretation that the EIDs are
exclusively human diseases
(79). Pathogens damaging
livestock and crops are therefore seldom connected to those creating
illness in humans, despite the anthropogenic drivers of their emergence
(globalisation, climate change, international travel and shipping, human
intrusion, etc.) and the socioeconomic impacts being the same in both
severity and magnitude
(18,46,51,80).
Policy silos can further be observed in livestock diseases being
addressed by food safety regulations and production management, while
crop diseases being the concern of agricultural policies. Nevertheless,
not only are the drivers of disease emergence the same, but pathogens
colonising livestock and crops can increase the probability of emerging
human diseases (45).
The One Health initiative considers all novel diseases a direct threat
to human wellbeing and has been working to implement the One Health
approach to medical, veterinary and wildlife disease management, urging
for large scale, merged databases, expanding research focus to wild
populations and reservoirs and preparing for future emergences
(73,81,82). In
line with these efforts, the DAMA calls for preventive intervention
against all pathogens with a potential to emerge in human, livestock or
crop populations. At the same time, this also means that prevention has
to be planned and executed in three different policy environments. In
the following sections, we will present the main focus points, target
stakeholders and typical stumbling blocks of establishing LLs and CS
programs in different policy infrastructures.
Human pathogens
Human diseases come under the deepest scrutiny and attract the most
attention from authorities and the public alike. Nevertheless, there is
major divergence between countries and regions in terms of healthcare
infrastructure, pathogen diversity and sources of potential emergence.
While temperate zone regions are more exposed to air-travel related
infections being introduced
(17), tropical and
mediterranean areas have a higher potential for wildlife originated
emergences (83). These
patterns are then further complicated by climate change driving both
species and human migration, providing opportunity for disease to expand
their geographic, vector and host range. Chikungunya is an arboviral
infection spread by the yellow fever mosquito (Aedes aegypti ) and
was therefore referred to as a ‘tropical fever’ due its distribution
area limited to that of its vector. However, 2010 saw the virus
establish itself in the tiger mosquito (Aedes albopictus ) and
produce autochthonous cases in Southern Europe
(84), where it has since
developed self-sustaining populations
(85). Also an arbovirus
moving from the Ae. aegypti to the Ae. albopictus , the
ZIKA virus has seen its first local cases in Europe in 2019
(86) and is likely to
threaten over a billion people with its recent range expansion
(87). Finally, with the
recent outbreaks of hepatitis of unknown aetiology
(16) and the ongoing
monkeypox outbreaks (88), it
is clear that preparation for the barrage of human EIDs is
unsustainable. The focus needs to shift towards prevention by launching
multi-actor task forces handling emergence within a local and regional
setting.
Living Labs preventing
human pathogens
Preventing EIDs directly threatening human health will focus on the
interfaces between human communities and identified reservoir
populations where pathogens are expected to switch over to their new,
susceptible host. Exposure will often be increased by living and working
in close contact with wildlife (e.g. rural farming and hunting
communities) and/or limited access to healthcare services coupled with
improper maintenance of hygienic standards (e.g. urban poverty,
marginalised communities)
(1). Main focus points are
to control and minimise the chances of pathogens switching over to
humans, by either
targeting a specific host-pathogen system (e.g. Zika virus inAedes albopictus mosquitos) in which case we identify the
stakeholders affected by this system, or
targeting people whose circumstances (living conditions, occupation,
habits, etc.) supposedly place them at higher exposure (e.g. jobs
during COVID-19 that do not carry a home office option), in which case
we identify stakeholders connected to our target community.
From the groups outlined for LLs in general, the following actors should
be considered relevant to preventing high risk human EIDs.
Public actors - government authorities addressing public health
related matters, such as health services and public health authorities,
national laboratories and epidemiological surveillance facilities,
district health systems and district public health authorities and food
safety institutions.
Private actors - private companies and organisations affected
by potential emergence or connected to endangered communities. Relevant
examples include pharmaceutical companies producing treatment or
vaccines against the potential threat, travel agencies mapping
international routes of concern, or software development and data
management companies offering digital tools for tracking and monitoring
human-pathogen interfaces.
Knowledge institutions - scientific institutions focusing on
human pathogens, for instance epidemiology research laboratories,
veterinary research groups working on reservoirs or vectors of the
pathogen in question, and medical research institutions for human
diseases.
Local citizens - community members should be involved in
multi-actor task forces to represent local interest and expertise.
Priority should be given to those already participating in CS programs
or civil organisations, with an emphasis on engaging students and early
career youth.
LLs handling human diseases will rely heavily on personal data regarding
local workforce, financial status, access to health services, medical
history and connectivity, it is therefore crucial to secure data
protection and privacy. Furthermore, resources should be dedicated to
communicating the process to the local community through
paraprofessionals involved in the LL to establish solid working
relationships and trust between the task force and locals. Relying on a
collaborative foundation will not only facilitate implementation but
also foster long-term engagement for maintaining preventive monitoring
and screening.
Community Science programs
preventing human pathogens
The focal point of disease prevention measures is engaging and working
with communities directly exposed to the emergence of a novel pathogen.
As described for LLs (see above), the target population for CS programs
is identified (i) either through their contact with a particular
reservoir or (ii) their circumstances making them susceptible to
emergence of potential pathogens. Main focus points are to engage
members of a community and initiate bidirectional communication channels
between locals and researchers. On the one hand, prevention research
relies heavily on knowledge of local habits and lifestyle, traditions,
knowledge of reservoir behaviour and the interface between potential
pathogens and community members. On the other hand, researchers can
raise awareness on the lurking healthcare threat, establish educational
and training programs, involve locals in the project and solidify
collaboration by assigning leadership positions to paraprofessionals.
When planning recruitment within the community, factors to be considered
include setting (e.g. rural vs. urban), occupation (local trade unions,
commonalities between employment types, working conditions),
socio-economic status (access to healthcare, level of education,
household income) and cultural background (ethnicity, language, cultural
habits and traditions, religion, etc.). Recruiting and training programs
should be designed to be accessible and comprehensible for the target
population, with a clear explanation of why they had been selected as
participants.
Attention should be given to providing regular and thorough feedback on
the process to all members of the community. Activities should be
planned to ensure bidirectional flow of information: benefiting from
community engagement should always be coupled with feedback sessions
planned around delivering preliminary results, reflecting on experience
of involved (academic and community) members and discussing potential
impacts. This bidirectional discussion builds the trust and engagement
required to establish long-term programs and networks, and builds a
reliable network of non-scientific, local experts. Feedback should be
constant during the actual sampling/collection to not only give back to
the community, but to collect reflections and observations that can
improve methods and communication strategies. A public facing website
that is accessible for all stakeholders at all times is ideal, but
regular newsletters or social media are popular ways to communicate
effectively.
Contrary to LLs, CS programs are widely used to target infectious
disease threats by monitoring bacterial pathogens polluting water bodies
(89), preventing
Lyme-disease (90), or
monitoring viruses in urban environments
(54). Methods and practices
developed in previous programs should be implemented into newly
established initiatives focusing on prevention.
Livestock pathogens
Diseases emerging in livestock have been just as impactful as those
affecting humans directly. The past decades have seen an increase in
both frequency and magnitude, with pandemics plaguing livestock across
regions and continents
(91,92). However,
studies often focus on zoonoses rather than diseases affecting livestock
directly, creating a lack of available information on pathogens of
domesticated species (93).
This bias in research is fueled by preferential funding for zoonotic
diseases, which also manifests in lack of veterinary healthcare
infrastructure, low efficiency or high priced medications, lapses in
vaccination programs and knowledge discrepancies in breeders regarding
diseases (94,95).
Adding to the effects of this asymmetry in knowledge and research is the
management of livestock diseases, which primarily aims to eliminate
infected individuals from breeding stock, with extremely limited efforts
dedicated to treatment development
(96,97). Although there
have been suggestions to introduce preemptive hunting strategies to
avoid livestock being contaminated from wild populations
(98), prevention still has a
lot of ground to cover regarding livestock disease. This is further
certified by the major economic effects livestock pandemics have, which
add to the costs and damages caused by human EIDs. Foot and mouth
disease of cattle resulted in up to 88% market value losses, affecting
all actors along the cattle marketing chain in Uganda
(99), while leading to the
culling of 3.4 million animals during the UK epidemic
(100). African Swine Fever
has led to major economic losses in South-East Asia, and has triggered
policy modifications linked to the emergence of SARS-CoV-2
(45,51). Avian
influenza has not only led to dire losses in poultry production
(80) but also to pandemic
potential in humans (101).
Therefore, in line with the One Health approach calling for integrated
investigation of livestock, wildlife and human systems
(102,103), the DAMA
protocol calls for precautionary and preventive policies addressing
livestock diseases.
Living Labs preventing
livestock pathogens
Livestock disease will be of concern to different stakeholders than
human pathogens, although a considerable overlap is to be expected. The
drivers behind any preventive or managing intervention are mostly to
maintain production and livelihood of breeders and production plants.
Exposure will increase in free range breeding stocks and those housed
partly in external enclosures, while outbreaks will be more likely to
occur among high density stocks
(104). Main focus points are
to control and minimise the chances of pathogens switching over to
livestock, by either
targeting a specific host-pathogen system (e.g. ASF in wild boar
populations) in which case we identify the stakeholders affected by
this system, or
targeting breeding facilities and game populations whose circumstances
(housing conditions/distribution area, species, immediate surroundings
etc.) supposedly place them at higher exposure (e.g. frequent
encounters with (other) wildlife, limited access to
veterinary/wildlife services, lack of knowledge regarding
livestock/wildlife diseases, etc.), in which case we identify
stakeholders connected to our target facilities.
From the groups outlined for LLs in general, the following actors should
be considered relevant to preventing high risk livestock EIDs.
Public actors - government agencies involved in food safety,
including national level institutions (e.g. Food Safety and Inspection
Service (FSIS; US), Federal Institute of Risk Assessment (BIR; Germany),
Austrian Agency for Health and Food Safety (AGES; Austria), Fish and
Wildlife Department, as well as municipality level department of public
health, agriculture, hunting and food safety.
Private actors - private companies and enterprises whose main
activity is related to the livestock and/or game exposed to emergence. A
few examples include farms, processing plants, hunting associations,
suppliers and veterinary institutions providing vaccinations and
medication. In case they are active in the area of potential emergence,
companies offering digital tracking services recording movement,
development and other data on individual animals, will also have
valuable expertise in identifying interfaces and location of possible
intervention to reduce encounters between livestock and reservoirs.
Knowledge institutions - research groups targeting the
livestock and game pathogen under investigation as well as those
conducting research in livestock and wildlife vaccination, treatment,
methods to increase production and environmental effects on stock yield.
Furthermore, veterinary science is also a key stakeholder contributing
to knowledge on transmission, morbidity and mortality, and to potential
direction of treatment and/vaccine development.
Local citizens - required expertise will be found among
individual farmers and workers at breeding and processing facilities, as
well as hunters, who not only hold valuable insights regarding animal
behaviour and diseases but are also directly exposed to any emerging
pathogen due to their constant close contact with the breeding stock and
wildlife.
LLs handling livestock and game diseases must always consider that,
contrary to those dealing with human pathogens, they will have dual
priorities of preventing emergence and maintaining or even increasing
production. As livelihood of most stakeholders is closely connected to
yield of breeding stocks and game populations, tools such as culling or
restricting stock size, increasing hunting bag size or applying targeted
hunting should be used with extraordinary caution to establish long-term
feasibility of prevention methods.
Community Science programs
preventing livestock pathogens
CS programs targeting livestock diseases are far less common than those
addressing human pathogens, since the community affected by them is much
smaller and consists almost exclusively of citizens working in livestock
breeding or processing and hunters. Whether a CS initiative is designed
to target (i) a particular pathogen and the livestock or game exposed to
it or (ii) breeding stocks and game populations whose circumstances make
them susceptible to emergence of potential pathogens, the initiative
will be of interest to a narrower community of local experts.
Main focus points are to engage breeding experts and individual hunters
that work in close contact with animals and are aware of the day-to-day
issues and conditions of a breeding/processing facility or a particular
hunting area. Livestock experts will be able to identify interfaces
between the stock and wildlife accurately, while hunters will be
familiar with movement and behavioural patterns of game and potential
reservoirs, as well as population sizes and demography.
When planning recruitment strategies, a close collaboration is required
with the management of the breeding facility(s) for efficient study
design and institutional encouragement to participate. It is also
necessary to align interests of larger breeding enterprises and
small-scale, local farmers to ensure the homogeneity of data collected.
An additional opportunity lies in designing studies for the general
audiences, targeting those that are active outdoors and therefore have
occasional encounters with wildlife. Recruiting and training programs
should be designed to be accessible and comprehensible for the target
population, with a clear explanation of why they had been selected as
participants.
To avoid unnecessary investment, planning must always consider existing
data collected by breeders and hunters, as both institutions collect
particular types of data on a permanent basis. This is available either
from government institutions overseeing wildlife management or private
breeders keeping their own records, both subject to restricted access.
Similarly, feedback sessions and reports have to be targeted to both
citizen participants and the institutional board overseeing the stock in
question, which can alter the format of the feedback.
CS programs have been introduced into research focusing on wildlife
health surveillance (75) as
well as monitoring invasive vector species
(55). Studies have also used
CS methods to target diseases plaguing wildlife and livestock
simultaneously (105) and to
identify shortcomings of policies addressing foot and mouth disease
(106).
Crop pathogens
Crop pathogens are commonly the most neglected EIDs since they pose no
immediate health risk to humans and therefore mostly manifest in
indirect effects due to decreased production. Crop pathogens have
typically been addressed by palliative efforts eliminating them from the
cultivated plant stock
(107,108) or later
applying defence priming against known crop diseases
(109). Macroscopic pests of
crops have a longer history of defence strategies, as microscopic
pathogens had only been discovered to coincide with plant diseases in
the late XIXth century and named as a cause decades later
(110). Initial research
focus gradually shifted from epidemiology towards control and founded
commercial disease control with a wide range of bactericide, fungicide
and virucide treatments, as well as extensive gene-modification research
breeding resistant crops lineages
(110). Although without such
protection measures, losses in crop production could increase five-fold
in Europe (111), it has now
become clear that global demand as well as changing climate and
globalised trade have subjected crops to EIDs unmanageable by current
measures. Additional to coconut yellow disease and wheat stem rust
described above, tomatoes are plagued by rapidly spreading, diverse
viral diseases (112),
grapevine downey mildew has spread from Europe and now threatened
vineyards worldwide (113),
and the Fusarium incarnatum-equiseti species complex had invaded leafy
vegetable crops in novel European areas
(114). Although still
treated as an agricultural and production issue, more studies are
connecting plant diseases to the larger context of EIDs
(115–117). In
line with this, evidence shows that plant pathogens follow similar
evolutionary trajectories to those described in the Stockholm Paradigm,
for instance Phytoplasmas using common receptors distributed across
several insects that serve as vectors to infect plants
(118,119).
Although the overlap between plant and human pathogens is presumably
negligible, the effect of emerging plant pathogens on global food
security is devastating, which justifies their inclusion within the
preventive measures of the DAMA protocol.
Living Labs preventing crop
pathogens
Crop pathogens will be of interest to stakeholders quite different than
described for human and livestock diseases, with smaller overlaps.
However, some similarities will exist between motivation for preventing
crop and livestock EIDs, namely the drive to maintain production and
yield of crops. Also, exposure will increase in those planted in the
vicinity of wild areas, with large scale monocultural fields being at
elevated risk of epidemics and outbreaks. Additionally, growing similar
species in close spatial or temporal proximity may further increase the
chances of transferring pathogens from one to the other
(120). Main focus points are
to control and minimise the chances of pathogens switching over to crop
plants, by either
targeting a specific host-pathogen system (e.g. phytoplasma in their
vector insects) in which case we identify the stakeholders affected by
this system, or
targeting areas or particular crops whose circumstances (distribution
area, species, immediate surroundings etc.) supposedly place them at
higher exposure (e.g. large areas bordering natural habitats, limited
access to agricultural and control services, lack of knowledge
regarding crop diseases, etc.), in which case we identify stakeholders
connected to our target areas or species.
From the groups outlined for LLs in general, the following actors should
be considered relevant to preventing high risk crop EIDs.
Public actors - government ministries involved in agricultural
services, including national level institutions (e.g. National Institute
of Food and Agriculture (NIFA; US), Federal Ministry of Food and
Agriculture (Germany), Federal Ministry of Agriculture (Austria), as
well as municipality level departments of public health, agriculture,
and food safety.
Private actors - private companies and enterprises whose main
activity is related to the crop and/or area exposed to emergence. A few
examples include farms, plantations, suppliers and agricultural
institutions providing protection methods. In case they are active in
the area of potential emergence, companies offering digital mapping
services recording distribution, density, species composition, and other
data in high resolution, will also have valuable expertise in
identifying interfaces and location of possible intervention.
Knowledge institutions - research groups involved in agri-food
sciences relating to the emergent threat, working on control measures
such as resistant lineages, pesticides, defence priming techniques, and
ways of increasing production, as well as those studying the
distribution and genetic mapping of the pathogen in question.
Local citizens - required expertise will be found among
individual farmers and workers working with investigated crops or in
relevant areas, as well as the general public visiting natural areas in
the vicinity of the cultivated plants. Both will have direct insights
into the manifestation and the distribution of the disease and will be
able to point out significant interfaces between crops and wild
reservoirs or hosts.
A further similarity to LLs handling livestock and game diseases, those
addressing crop diseases must also aim to prevent emergence and maintain
or increase production at the same time. Additionally, since current
control measures hold off substantial losses in production, prevention
measures must accommodate ongoing treatment protocols. Finally,
different regions will often have very different infrastructure on
cultivated areas, which will have a significant influence on the
potential prevention plans and their feasibility.
Although particular plant pathogens have been addressed by multi-actor
approaches targeting pathogens such as cassava viruses
(121), the Living Lab
approach is still to be utilised to its full potential in preventing and
controlling emerging crop diseases.
Community Science programs
preventing crop pathogens
Unlike in livestock diseases, CS programs tend to have a more thorough
representation in crop disease studies. This is mainly due to the
economic drivers of controlling crop pests as well as the larger
community of farmers and general public that is able to contribute.
Whether a CS initiative is designed to target (i) a particular pathogen
and the cultivated species exposed to it or (ii) crops whose
circumstances make them susceptible to emergence of potential pathogens,
the initiative will be of interest to a wider audience than in the case
of livestock diseases.
Main focus points are to engage farmers, cultivation experts and
individuals living or frequenting endangered areas, who will possess the
knowledge on crop and reservoir species as well as specifics on the area
of cultivation. Training programs should primarily focus on developing
skills to identify particular wild plant species and recognize signs of
infection, which will also be useful in tracking invasive species in the
future. Recruiting and training programs should be designed to be
accessible and comprehensible for the target population, with an
additional educational role in raising awareness about food security
issues and conscientious consumer behaviour. Depending on the setting of
the study, a long-term return can be encouraging participants to grow
produce at home, thereby increasing green areas and increasing
self-sustaining households.
The benefit of CS programs in crop health has been established regarding
potato diseases (122) and
identifying main threats of maize and soybean in the Amazon region
(123). Additionally, data
collected by a relatively small number of expert citizens has been
demonstrated to be highly accurate
(124), which makes CS
programs very promising for implementing the DAMA protocol.
Conclusions
The EID crisis represents one of the largest threats to modern
lifestyle, endangering human health, food security, economic and
societal systems. Isolated institutions dealing with various
manifestations of EIDs have thus far been unsuccessful in stopping the
wave of newly emergent pathogens. The SP provides a comprehensive
evolutionary framework, which replaces current, false characterization
of EIDs with clear predictions. The DAMA protocol provides a general
step-by-step plan for constructing preventive interventions targeting
emergent pathogens before the onset of an outbreak. This paper focuses
on the final step of implementing evolutionary theory into preventive
policies considering scales and policy environments.
Global, regional and local scales require precise conceptualization and
the introduction of adequate transdisciplinary methods to gather all
relevant knowledge and expertise, and create feasible, cost-efficient
intervention plans. Global integration of the DAMA protocol into
existing frameworks is crucial to provide useful guidelines to regional
and national institutions; this is described in the
Prevent-Prepare-Palliate (3P) framework. Regional scales addressing EID
threats are to introduce the widely tested approach of Living Labs,
which can be seen as multi-actor platforms delivering solutions
co-created by various stakeholders. Their application to infectious
disease threats will be a unique contribution which has significant
potential of dealing with diverging interests. Finally, local scales
would benefit from a wide-range of Community Science initiatives
targeting affected populations directly and the assistance of local
experts on various host-pathogen systems. Although each method is most
suitable for their particular scale, it is crucial that all of them
operate in close collaboration with each other, circulating knowledge
from the grassroots towards institutions. The key to disease prevention
is ongoing monitoring that engages local experts, citizens, as well as
relevant decision-makers in bidirectional communication.
Another important step towards more effectively controlling the EID
crisis is eliminating the barriers among human health care, wildlife
health care, livestock health care and crop health care. The current
lack of a unifying scientific understanding of health issues results in
divergent policies providing palliative and perhaps preparatory
solutions, none of which is efficient or sustainable in the face of
accelerating EIDs. By understanding the common underlying evolutionary
drivers, predictions can be adjusted appropriately across the board for
human, livestock and crop diseases, and prevention can be implemented
onto existing infrastructures and legal environments.
Our advancements in technology have brought with them novel threats in
the shape of EIDs. Climate change and globalisation have changed the
evolutionary trajectory of diseases as we know them, it is therefore
inevitable to change our approach to global health security and shift
our focus from reactive approaches to those moving up the infection
timeline towards prevention.